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The Peaks and Valleys of Medicine

THE RISE AND FALL OF MODERN MEDICINE; by Dr. James Le Fanu; Carroll & Graf; 426 pages, $26.

In this intriguing but academic volume, Dr. James Le Fanu reviews the moments in modern medicine that gave us longer, healthier lives, then argues that the engine driving medical innovation is slowing down. The pattern, says this British practitioner, is classic: In every field of human knowledge, there is a Golden Age, "followed by a decline in creativity and new ideas."

His Top 10 moments are, indeed, definitive and their stories exciting. The discovery of penicillin in 1941 immediately saved lives and led to other antibiotics. The innovation of open-heart surgery in 1955 made heart defects survivable and paved the way for transplants. The 1984 discovery that bacteria cause stomach ulcers revolutionized treatment of a condition formerly linked to stress and a bad diet.

But, Le Fanu writes, the pace of discovery slowed by the 1970s: Fewer doctors gravitated to research, physicians over-relied on expensive tests and on equipment that futilely prolonged some lives, and pharmaceutical companies came up with fewer new drugs. He rightly observes that although manufacturers have developed AIDS drugs and a hepatitis B vaccine, they mostly have generated variations of existing antidepressants, anti-inflammatories and antibiotics, while giving us lifestyle drugs like Viagra for impotence and Xenical for obesity.

Le Fanu says medicine's "fall" began in the 1980s, when experts looked to epidemiological origins of disease, such as poor diet and lifestyle, and sought answers in genetic manipulation.

Despite unlimited promise, genetic engineering, genetic screening and gene therapy have produced only slim benefits to date, he says. And although we're told that eating meat and high-fat dairy products may be at the root of heart disease and cancer, Le Fanu says it may very well be that such illnesses result from still-unidentified bacteria or viruses, or even agents like the prions behind mad cow disease.

His criticism here is legitimate: Perhaps we're relying too heavily on the fields of epidemiology and genetics to furnish answers to our toughest maladies. We may not be able to rely on our past pace to eliminate cancer, AIDS and Alzheimer's disease.

In his somewhat simplistic conclusion, Le Fanu suggests Western society stop putting a premium on progress "as an ideological necessity" and welcome progress as it comes. He advocates a return to old-fashioned medicine in which doctors exert their judgment, establish trusting relationships with patients and recognize the practical limits of what medicine can achieve.

That's all very well and good, but he doesn't address the reality of results-oriented managed care that is too far gone for that to occur--or results-oriented government funders wary of pouring taxpayer dollars into basic research that may not yield major benefits for years.

The biggest flaw in this book, however, is a plethora of inexcusable, sloppy errors. For example, Le Fanu misspelled the names of two leading lights in heart surgery: Dr. Walt Lillehei, the doctor who pioneered open-heart surgery at the University of Minnesota (incorrectly identified by Le Fanu as the University of Minneapolis), and Dr. Norman Shumway, a heart transplant surgeon at Stanford University, mistakenly identified as Stamford University.

Le Fanu, his researchers and editors should have caught these and others, like misspelling Genentech, the company that produced genetically engineered insulin. Such errors raise questions about where else Le Fanu's reporting might have gone astray.